Provider Demographics
NPI:1558434787
Name:DISHONG, MELISSA (SLP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:DISHONG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:GAUTHIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:18 SIMON STREET
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03061
Mailing Address - Country:US
Mailing Address - Phone:603-883-8205
Mailing Address - Fax:603-881-7198
Practice Address - Street 1:144 CANAL STREET
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03064
Practice Address - Country:US
Practice Address - Phone:603-882-6333
Practice Address - Fax:603-889-5460
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0737235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH761242OtherTUFTS
NH272746OtherCIGNA
NH561822OtherAETNA
NH626514OtherHARVARD PILGRIM
NH99560056Medicaid